Download Cardiac Valve Replacement: Current Status by Shahbudin Rahimtoola (auth.), Jack M. Matloff M.D. (eds.) PDF

By Shahbudin Rahimtoola (auth.), Jack M. Matloff M.D. (eds.)

Cardiac Valve substitute: present prestige is the lawsuits of the Fourth Interna­ tional Symposium at the ST. JUDE scientific@ valve. the 1st 3 symposia in this subject have been held essentially for distinctive investigators focused on scientific trials of the ST. JUDE clinical valve. The final assembly, chaired by way of Michael E. DeBakey, M.D., was once held in November 1982 [1], instantly prior to the valve was once published for basic medical use within the usa via the nutrients and Drug management. those complaints then are the 1st finished compilation of scientific information due to the fact that that point; they usually contain, quite within the discussions, the adventure of physicians except the unique medical investigators. over the last five years the nature of those symposia has replaced. while the 1st dealt virtually solely with the ST. JUDE clinical valve, the final have developed right into a extra customary cardiac valvular surgical procedure assembly, focusing totally on valve substitute instead of valve fix [2]. therefore, those continue­ ings include a large spectrum of issues, together with a keynote presentation on standards for number of cardiac valve substitutes in 1984, issues of cardiac valve substitute and their therapy, a evaluation of the present prestige of cardiac valve substitutes except the ST. JUDE scientific valve and a attention of cardiac valve substitute in distinct situations. between those exact circum­ stances are 4 displays on pediatric use of the ST. JUDE clinical valve.

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SURVIVAL Actuarial survival at 5 years following reoperation was 73% and at 7 years 70%. These figures are somewhat lower than what we anticipate following initial valve replacement. A similar group of patients undergoing first valve operations who were followed from 1973 to 1978 had an actuarial survival of 84%. Although reoperation may have a negative effect on survival, the lower survival rates appear to be related to preoperative NYHA Classification. For Class I and Class II mitral patients, survival at 7 years following reoperation was 94% and for aortic patients of the same Classes the survival was 80%.

A similar study performed at the Mayo Clinic 10 years later [7] showed essentially the same data and no difference in the incidence of bleeding. These studies show that warfarin sodium plus dipyridamole appears, in certain patients, to reduce the incidence of thromboembolism with mechanical valves. There was a significant increase in bleeding when aspirin was used, suggesting that patients with mechanical valves should not be treated with aspirin and warfarin sodium. Steele, et al. [8] in 1979 showed there is a select group of patients who have reduced platelet survival who would particularly benefit by an addition of an antiplatelet agent to their COUMADIN therapy.

Bull Georgetown U Med Cent 1953; 6:60. 2. Harken DE, SoroffHS, Taylor WJ, et al: Partial and complete prostheses in aortic insufficiency. J Thorac Cardiovasc Surg 1960; 40:744-762. xxxiv Keynote Address: Cardiac Valvular Surgery, 1984 3. Starr A, Edwards ML: Mitral replacement: Clinical experience with a ball-valve prosthesis. Ann Surg 1961; 154:726-740. 4. Williams JB: US Patent No 19323, February 9, 1858. 5. Starr A, Pierie WR, Raible DA, et al: Cardiac valve replacement: Experience with the durability of silicone rubber.

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